Patient Forms and Office Policies

We welcome new patients to Ellenton Pediatrics. To expedite your first visit, please print, complete and review the New Patient Registration Packet and fill it out before your appointment. Be sure to take your insurance card and photo identification with you to your first visit.

If you are already established with our practice, please inform us promptly of any changes of your address, phone number, or insurance. If you are changing your insurance plans, please first check with your new plan if we are in the network, fax or mail us a legible copy of both sides of your new insurance card or bring it to your upcoming visit.

If the adult accompanying your child to our office is not already listed on her/his Parental Authorization Form, please fill it out and either fax it to our office at 941-723-7844, or send it in with your child.

If you are moving and know where your new doctor's office will be, you may fill out the Release of Medical Records form now. There will be a charge for copying and mailing records.

Activity Participation Forms

If you require a form for daycare, pre-school, camp, sports physicals or any other activity we request you bring the form with you to your child’s well exam. If you request a form to be filled out at a later date, please allow at least 48 hours for the form to be completed. Currently, there is no charge for completing these forms. We do ask, however, that you make sure your account is in good standing with us.

Florida High School Athletic Association requires a Preparticipation Physical Evaluation Form be filled yearly before the start of the season. Click this link to access and download the form:

Preparticipation Physical Evaluation Form

The parent or student must complete the first page before the provider can sign the form.

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